USA Health, University of South Alabama Winston-Salem, NC
Omsai K. Meka, MD1, William Sonnier, MD2 1USA Health, University of South Alabama, Winston-Salem, NC; 2University of South Alabama College of Medicine, Mobile, AL Introduction: Tumor necrosis factor (TNF)-alpha inhibitors (TNF-α inhibitors) play a pivotal role in managing disease progression in patients with Crohn’s Disease. However, one known adverse effect associated with TNF-α inhibitor use is risk of malignancy. This case report seeks to demonstrate a potential association between adalimumab use and development of malignancy.
Case Description/
Methods: Patient is a 42-year-old woman with pertinent past medical history of fistulizing Crohn’s Disease who presented to ED with concerns of suprapubic pain, nausea, and bloating. She had been on Adalimumab with satisfactory control of Crohn’s Disease. Imaging, including MRI Pelvis WWO Con, noted a 14-cm heterogeneous multilobulated left ovarian mass concerning for malignancy. Gynecologic Oncology evaluated patient and performed total hysterectomy & salpingo-oophorectomy. Additional workup by Medical Oncology, including pathology, staging studies, and genetic testing, established BRAF mutated stage IV "M1" melanoma of the left ovary with peritoneal, lung, and bone metastasis with no teratoma noted. She reported no risk factors for primary ovarian melanoma including prior history of melanoma/malignancy, significant exposure to chemicals, unprotected UV exposure, and family history of malignancy. She was switched to Vedolizumab and is on chemotherapy regimen consisting of dabrafenib & trametinib with satisfactory response based on repeat staging studies. Discussion: As in this patient who had no risk factors for primary ovarian melanoma, there is concern that TNF-α inhibitor therapy is associated with increased risk of malignancy. As TNF-α inhibition leads to reduced immune surveillance, pre-malignant cells can evade detection and progress to advanced tumor spread. While adalimumab has efficacy in managing fistulizing Crohn’s disease, malignancy risk with treatment must be discussed prior to initiation of any TNF-α inhibitor. One study noted an increased relative risk of 1.8 for adalimumab-associated melanoma development. Another case report demonstrated similar concern for primary malignant melanoma development in patients who are on TNF-α inhibitor. To further assess risk of malignancy development in TNF-α inhibitor use, large center studies are necessary as existing studies portray a mixed but concerning opinion. Although TNF-α inhibitor therapy risks were studied in patients with Rheumatoid Arthritis, large center RCTs are required to evaluate links between TNF-α inhibitor therapy in IBD and malignancy.
Disclosures: Omsai Meka indicated no relevant financial relationships. William Sonnier: Abbvie – Speakers Bureau. Eli Lily – Speakers Bureau.
Omsai K. Meka, MD1, William Sonnier, MD2. P3361 - Metastatic Primary Ovarian Melanoma Following TNF-α Inhibitor Use for Fistulizing Crohn’s Disease, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
